Residential medium-term centers are among the treatment facilities available for women with substance use disorders in Iran. This qualitative study aimed to explore the lived experiences of women undergoing treatment for substance use disorders at residential medium-term rehabilitation centers in Sanandaj, the capital city of Kurdistan Province in western Iran. This qualitative study employed content analysis to explore the experiences of women undergoing residential treatment for substance use disorders. Seventeen women were purposively selected from a women-only rehabilitation center for participation in semi-structured interviews. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. Data analysis revealed two main categories related to the participants’ experiences with substance use disorder treatment at residential medium-term care centers: (1) Inhibiting factors, including unsuitable family situations, economic hardship, structural barriers, physical and environmental obstacles, lack of continuity of care, and comorbid health conditions; and (2) Facilitating factors, such as a drug-free environment, a comprehensive treatment curriculum, peer support, and access to psychological services. Based on the findings of this study, it can be concluded that various factors influence the recovery and rehabilitation process of women with substance use disorders. Overall, increasing awareness of these factors and designing interventions tailored to address them may contribute to improving quality of life and promoting sustained abstinence among these individuals.

BackgroundIn 2016, The World Health Organization introduced HIV self-testing (HIVST) as an alternative to traditional HIV testing (1), the present study aims to study the acceptability of HIV self-testing among Iranian women injecting drug users (WIDUs). The results of this study are expected to provide valuable evidence for the proper implementation of this program in Iran. Methods: This study employed a content analysis approach to gather qualitative data. The investigation was conducted from April to July 2023. We have chosen the following five provinces, namely Mashhad, Tehran, Kurdistan, Mazandaran, and Kerman, as the designated areas for our study. A sample of Iranians (17-62 years) was selected by purposeful and snowball sampling methods to participate in the study, and 31 semi-structured interviews were conducted. The data collection tool was an interview guide, which was designed based on a review of the literature. The data were analyzed using conventional content analysis. The interviews continued until data saturation was reached. Results: Based on our findings, we distilled 2 main themes and 9 categories including Inhibiting factors (Access and Affordability, Accuracy Concerns, Low knowledge, linkage to HIV treatment, the window period, Ignoring the danger) and Focalizing factors (Empowerment and autonomy, Stigma and privacy.ConclusionIran's HIV stigma may discourage regular testing, but self-testing can help overcome challenges. Support for counseling, care links, and accurate information dissemination are crucial.

AIMS:We measured the association between a history of incarceration and HIV positivity among people who inject drugs (PWID) across Europe.DESIGN, SETTING AND PARTICIPANTS:This was a cross-sectional, multi-site, multi-year propensity-score matched analysis conducted in Europe. Participants comprised community-recruited PWID who reported a recent injection (within the last 12 months).MEASUREMENTS:Data on incarceration history, demographics, substance use, sexual behavior and harm reduction service use originated from cross-sectional studies among PWID in Europe. Our primary outcome was HIV status. Generalized linear mixed models and propensity-score matching were used to compare HIV status between ever- and never-incarcerated PWID.FINDINGS:Among 43 807 PWID from 82 studies surveyed (in 22 sites and 13 countries), 58.7% reported having ever been in prison and 7.16% (n = 3099) tested HIV-positive. Incarceration was associated with 30% higher odds of HIV infection [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.09-1.59]; the association between a history of incarceration and HIV infection was strongest among PWID, with the lowest estimated propensity-score for having a history of incarceration (aOR = 1.78, 95% CI = 1.47-2.16). Additionally, mainly injecting cocaine and/or opioids (aOR = 2.16, 95% CI = 1.33-3.53), increased duration of injecting drugs (per 8 years aOR = 1.31, 95% CI = 1.16-1.48), ever sharing needles/syringes (aOR = 1.91, 95% CI = 1.59-2.28) and increased income inequality among the general population (measured by the Gini index, aOR = 1.34, 95% CI = 1.18-1.51) were associated with a higher odds of HIV infection. Older age (per 8 years aOR = 0.84, 95% CI = 0.76-0.94), male sex (aOR = 0.77, 95% CI = 0.65-0.91) and reporting pharmacies as the main source of clean syringes (aOR = 0.72, 95% CI = 0.59-0.88) were associated with lower odds of HIV positivity.CONCLUSIONS:A history of incarceration appears to be independently associated with HIV infection among people who inject drugs (PWID) in Europe, with a stronger effect among PWID with lower probability of incarceration.

ObjectivesIncarcerated people are at higher risk for HIV, Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV) infections. This review systematically summarized the evidence on the prevalence of these infections among incarcerated people in Iran.Study designA systematic review and meta-analysis.MethodsWe searched Embase, PubMed, Web of Science, Scopus, PsychInfo, Iranian databases, including IranMedex, Magiran, Scientific Information Database (SID), and IranDoc. A grey literature review was conducted to find unpublished reports from the Ministry of Health and experts throughout the country. Included studies reported data on the prevalence of HIV, HBV, or HCV infections. A random-effects meta-analysis was performed to estimate the pooled prevalence. A meta-regression analysis was also conducted.ResultsOf 1461 screened records, 23 records were eligible (total participants = 199,855). The pooled prevalence of HIV (17 studies), HBV (6 studies), and HCV (10 studies) was 2.77% (95% CI: 1.96, 3.70), 2.89% (95% CI: 2.28, 3.56), and 21.57% (95% CI: 13.62, 30.76), respectively. Meta-regression analyses showed that HIV (P-value = 0.05) and HCV (P-value = 0.02) were reduced over time using survey year as the interested variable in the model. Also, lifetime history of drug injection had a significant association with the HIV infection (P-value = 0.03).ConclusionThe findings suggest that the prevalences of these infections are relatively considerable among Iranian incarcerated people. These findings support developing interventions to reduce the risk of the acquisition and circulation of these infections among incarcerated people, and continued harm reduction programs among most at-risk incarcerated people, as well as HCV treatment.

Purpose People in prison are at a higher risk of preventable mortality from infectious disease such as human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), hepatitis B (HBV), hepatitis C (HCV) and tuberculosis (TB) than those in the community. The extent of infectious disease-related mortality within the prison setting remains unclear. The purpose of this paper was to collate available information on infectious disease-related mortality, including the number of deaths and calculate the person-time death rate. Design/methodology/approach The authors searched databases between 1 January 2000 and 18 November 2020 for studies reporting HIV, HBV, HCV, TB and/or HIV/TB-related deaths among people in prison. Findings The authors identified 78 publications drawn from seven Joint United Nations Programme on HIV/AIDS' regions encompassing 33 countries and reporting on 6,568 deaths in prison over a 20-year period. HIV/AIDS (n = 3,305) was associated with the highest number of deaths, followed by TB (n = 2,892), HCV (n = 189), HIV/TB (n = 173) and HBV (n = 9). Due to the limitations of the available published data, it was not possible to meta-analyse or in any other way synthesise the available evidence. Research limitations/implications To inform targeted efforts to reduce mortality, there is a need for more, better quality data to understand infectious disease-related mortality in custodial settings. Increased investment in the prevention and management of infectious diseases in custodial settings, and in documenting infectious disease-related deaths in prison, is warranted and will yield public health benefits. Originality/value To the authors' best knowledge, this is the first scoping review focussed on deaths due to these infections among people in prison internationally. The gaps identified form recommendations to improve the future collection and reporting of prison mortality data.

PURPOSE:This paper aims to determine whether a single session of a motivational interview (MI) reduces smoking relapse amongst people released from smoke-free prisons.DESIGN/METHODOLOGY/APPROACH:This study sought to recruit 824 ex-smokers from 2 smoke-free prisons in the Northern Territory, Australia. Participants were randomised to receive either one session (45-60 min) face-to-face MI intervention 4-6 weeks prior to release or usual care (UC) without smoking advice. The primary outcome was continuous smoking abstinence verified by exhaled carbon monoxide test (<5 ppm) at three months post-release. Secondary outcomes included seven-day point-prevalence, time to the first cigarette and the daily number of cigarettes smoked after release.FINDINGS:From April 2017 to March 2018, a total of 557 participants were randomised to receive the MI (n = 266) or UC (n = 291), with 75% and 77% being followed up, respectively. There was no significant between-group difference in continuous abstinence (MI 8.6% vs UC 7.4%, risk ratio = 1.16, 95%CI 0.67∼2.03). Of all participants, 66.9% relapsed on the day of release and 90.2% relapsed within three months. On average, participants in the MI group smoked one less cigarette daily than those in the UC within the three months after release (p < 0.01).RESEARCH LIMITATIONS/IMPLICATIONS:A single-session of MI is insufficient to reduce relapse after release from a smoke-free prison. However, prison release remains an appealing time window to build on the public health benefit of smoke-free prisons. Further research is needed to develop both pre- and post-release interventions that provide continuity of care for relapse prevention.ORIGINALITY/VALUE:This study is the first Australian randomised controlled trial to evaluate a pre-release MI intervention on smoking relapse prevention amongst people released from smoke-free prisons.

Background Illicit drug use and dependence is a well-established risk factor for self-harm and suicide. The present comparative study aimed to evaluate the prevalence of suicidal ideation and suicide attempt among Iranian women.Methods With a cross-sectional design, a total of 787 Iranian women who reported using illicit drugs and 406 women without drug use history were recruited and invited to answer questions regarding their socio-demographic status, individual health conditions, interpersonal information, e.g. experience of sexual, verbal, or physical violence, illicit drug use, and history of suicidal ideation and suicide attempt. Data were collected through gender-matched interviews. Generalized Linear Models (GLM) with Poisson family and log link function were used to report adjusted prevalence ratios (APR) of the associated factors of the study outcomes.Results The mean age (SD) of women with and without drug use was 34.3 (9.2) and 30.5 (11.0) years, respectively. Prevalence of lifetime history of both suicidal ideation (38.54 vs 19.01%) and suicide attempt (26.25 vs 6.55%) was significantly higher among women reporting drug use compared to those reporting no drug use. The APR of the associated factors ranged from 1.8 to 3.1 and from 3.3 to 4.8 for suicidal ideation and suicide attempt, respectively.Conclusion Women who use drugs are at greater risk of suicidal ideation and suicide attempt compared with their peers who do not use drugs. Although further studies are required to explore possible causal relationships between drug use and suicide among Iranian women, a comprehensive package of care and treatment in addition to predominantly drug-related harm reduction programs may help address such critical health issues among Iranian women who use drugs.

BackgroundPeople who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes.AimWe aimed to estimate the associations between a history of incarceration and prevalence of HIV and HCV infection among PWID in Europe.MethodsAggregate data from PWID recruited in drug services (excluding prison services) or elsewhere in the community were reported by 17 of 30 countries (16 per virus) collaborating in a European drug monitoring system (2006-2020; n = 52,368 HIV+/-; n = 47,268 HCV+/-). Country-specific odds ratios (OR) and prevalence ratios (PR) were calculated from country totals of HIV and HCV antibody status and self-reported life-time incarceration history, and pooled using meta-analyses. Country-specific and overall population attributable risk (PAR) were estimated using pooled PR.ResultsUnivariable HIV OR ranged between 0.73 and 6.37 (median: 2.1; pooled OR: 1.92; 95% CI: 1.52-2.42). Pooled PR was 1.66 (95% CI 1.38-1.98), giving a PAR of 25.8% (95% CI 16.7-34.0). Univariable anti-HCV OR ranged between 1.06 and 5.04 (median: 2.70; pooled OR: 2.51; 95% CI: 2.17-2.91). Pooled PR was 1.42 (95% CI: 1.28-1.58) and PAR 16.7% (95% CI: 11.8-21.7). Subgroup analyses showed differences in the OR for HCV by geographical region, with lower estimates in southern Europe.ConclusionIn univariable analysis, a history of incarceration was associated with positive HIV and HCV serostatus among PWID in Europe. Applying the precautionary principle would suggest finding alternatives to incarceration of PWID and strengthening health and social services in prison and after release ('throughcare').

The large and growing population of people who experience incarceration makes prison health an essential component of public health and a critical setting for reducing health inequities. People who experience incarceration have a high burden of physical and mental health care needs and have poor health outcomes. Addressing these health disparities requires effective governance and accountability for prison health care services, including delivery of quality care in custody and effective integration with community health services. Despite the importance of prison health care governance, little is known about how prison health services are structured and funded or the methods and processes by which they are held accountable. A number of national and subnational jurisdictions have moved prison health care services under their ministry of health, in alignment with recommendations by the World Health Organization and the United Nations Office on Drugs and Crime. However, there is a critical lack of evidence on current governance models and an urgent need for evaluation and research, particularly in low- and middle-income countries. Here we discuss why understanding and implementing effective prison health governance models is a critical component of addressing health inequities at the global level.

With a worldwide prevalence of 15.4%, hepatitis C virus (HCV) has been estimated to be the most prevalent major infectious disease in prisons. The exceptionally high prevalence of HCV in prisons is attributable to common risk behaviors including sharing contaminated tattooing equipment and drug paraphernalia, as well as lack of HCV control interventions including needle and syringe programs. Despite the importance of attention to prisoners as a highly at-risk population to acquire and transmit HCV, the number of HCV research and policy documents ignoring prisoners is increasing. Highlighting this issue, the present manuscript discusses how excluding prisoners from HCV-related research and policies will jeopardize the global HCV elimination goals set forth by the global community.

INTRODUCTION:More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance. OBJECTIVES:To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison. METHODS:We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology. RESULTS:The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up. CONCLUSIONS:The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population. KEY WORDS:Mortality; incarceration; prison; release; individual participant data meta-analysis; consortium; cohort.

With a worldwide prevalence of 15.4%, hepatitis C virus (HCV) has been estimated to be the most prevalent major infectious disease in prisons. The exceptionally high prevalence of HCV in prisons is attributable to common risk behaviors including sharing contaminated tattooing equipment and drug paraphernalia, as well as lack of HCV control interventions including needle and syringe programs. Despite the importance of attention to prisoners as a highly at-risk population to acquire and transmit HCV, the number of HCV research and policy documents ignoring prisoners is increasing. Highlighting this issue, the present manuscript discusses how excluding prisoners from HCV-related research and policies will jeopardize the global HCV elimination goals set forth by the global community.

BACKGROUND:Female sex workers (FSWs) experience adversities regarding social determinants of health (SDH) and behavioural factors including illicit drug use. This study aimed to assess the clustered impact of SDH on illicit drug use among FSWs in Iran.METHODS:We surveyed 1,347 FSWs in 13 major cities in 2015. Latent class analysis was conducted to identify distinct classes of five measured SDH including low education, unemployment, unstable housing, last-year incarceration and sexual violence. We examined the association of these classes with five illicit drug use patterns using multivariable generalized linear model with Poisson family and log link, and reported adjusted prevalence ratios (aPR) and their 95% confidence intervals (CI).RESULTS:We identified five SDH classes: Class 1: no SDH adversities; Class 2: mainly unemployment; Class 3: low education and unemployment; Class 4: sexual violence and unemployment; and Class 5: multiple SDH adversities. The prevalence of last-month drug use ranged from 7.0% in Class 1 to 53.3% in Class 5. Compared to FSWs in Class 1, those in Class 2 (aPR: 2.47, 95% CI: 1.15, 5.27), Class 3 (aPR: 3.69, 95% CI: 1.62, 8.36), Class 4 (aPR: 4.49, 95% CI: 1.71, 11.78) and Class 5 (aPR: 6.35, 95% CI: 2.42, 16.69) were more likely to report last-month drug use. The same patterns were observed for specific drugs of opium use, crystal methamphetamine use, and heroin-crack use, as well as poly-drug use.CONCLUSION:Socio-structural determinants are clustered together and elevate the likelihood of illicit drug use among FSWs. Our findings highlighted the significance of assessing and addressing such key determinants of health in drug use harm reduction programs targeting FSWs.

Needle and syringe programs (NSPs) are among the most effective interventions for controlling the transmission of infection among people who inject drugs in prisons. We evaluated the availability, accessibility, and coverage of NSPs in prisons in European Union (EU) countries. In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, we systematically searched 4 databases of peer-reviewed publications (MEDLINE (PubMed), ISI Web of Science, EBSCO, and ScienceDirect) and 53 databases containing gray literature to collect data published from January 2008 to August 2018. A total of 23,969 documents (17,297 papers and 6,672 gray documents) were identified, of which 26 were included in the study. In 2018, imprisonment rates in 28 EU countries ranged between 51 per 100,000 population in Finland and 235 per 100,000 population in Lithuania. Only 4 countries were found to have NSPs in prisons: Germany (in 1 prison), Luxembourg (no coverage data were found), Romania (available in more than 50% of prisons), and Spain (in all prisons). Portugal stopped an NSP after a 6-month pilot phase. Despite the protective impact of prison-based NSPs on infection transmission, only 4 EU countries distribute sterile syringes among people who inject drugs in prisons, and coverage of the programs within these countries is very low. Since most prisoners will eventually return to the community, lack of NSPs in EU prisons not only is a threat to the health of prisoners but also endangers public health.

BACKGROUND:The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. METHODS:Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. RESULTS:For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. CONCLUSIONS:The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.

Purpose - The aim of present study was to integrate vital noncommunicable diseases (coronary artery disease, hypertension, diabetes mellitus and mental health disorders) into Prison-Based Active Health Services Provision (PAHSP). Design/methodology/approach - On Jan 1, 2018, there were 230,000 prisoners in Iran. Timely and systematic detection and diagnosis of chronic health conditions among this population are imperative. The collaboration between healthcare providers in prison and members of the multidisciplinary team of the healthcare community outside prison initiated an active health service provision approach for HIV and tuberculosis (TB). Guidelines for the control of HIV and TB in prison were piloted, and the finalized version was named "Prison-based Active Health Services Provision" (PAHSP), which has been scaled up in 16 of 260 Iranian prisons. Finding - The PAHSP approach emphasizes the importance of early identification of key symptoms and risk factors. This approach provides an opportunity for improved prevention and treatment, enabling prisoners identified at risk or those who have been diagnosed with a target disease to be followed up and receive the appropriate health care. Originality/value - Initiatives such as screening for chronic health conditions coupled with treatment will reduce the burden of chronic illness among prisoners and the broader community, thereby saving on healthcare costs and lives.

This chapter outlines the effects of the three different types of drugs: stimulants, depressants and hallucinogens. Illicit drug use and injecting drug use are relatively uncommon in Australia. Australia's approach to drugs is outlined in the National Drug Strategy, which commenced in 1985. The Strategy has two components—supply reduction measures and demand reduction initiatives—with an overall aim of minimising the harmful effects of drugs on Australian society. Dependence on drugs can be psychological or physical. The former is characterised by a strong desire to take the drug, an inability to control use, persistent use despite harmful consequences and the prioritisation of drug use over activities. Detoxification is the process whereby the drug is eliminated from the user's system. The chapter examines and identifies the world trends relating to drug treatment and prevention and associated issues. Supply reduction initiatives typically involve law enforcement agencies to curb the manufacture, importation and distribution of illicit drugs.

Surveillance of HIV/AIDS mortality is crucial to evaluate a country’s response to the disease. With a modified estimation approach, this study aimed to provide more accurate estimates on deaths due to HIV/AIDS in Iran from 1990 to 2015 at national and sub-national levels. Using a comprehensive data set, death registration incompleteness and misclassification were addressed by demographical and statistical methods. Trends of mortality due to HIV/AIDS at national and sub-national levels were estimated by applying a set of models. A total of 474 men (95% uncertainty interval [UI]: 175–1332) and 256 women (95% UI: 36–1871) died due to HIV/AIDS in 2015 in Iran. Peaked in 1995, HIV/AIDS-related mortality has steadily declined among both genders. Mortality rates were remarkably higher among men than women during the period studied. At the sub-national level, the highest and the lowest annual percent change were found at 10.97 and −1.36% for women, and 4.04 and −3.47% for men, respectively. The findings of our study (731 deaths) were remarkably lower than the Joint United Nations Programme on HIV and AIDS (4000) but higher than Global Burden of Disease (339) estimates in 2015. The overall decrease in mortality due to HIV/AIDS may be attributed to the increasing burden of noncommunicable diseases; however, the role of the national and international organizations to fight HIV/AIDS should not be overlooked. To decrease HIV/AIDS mortality and to achieve international goals, evidence-based action is required. To fast-track targets, the priority must be to prevent infection, promote early diagnosis, provide access to treatment, and to ensure treatment adherence among patients.